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Vol. 49. Núm. 3.
Páginas 75-78 (marzo 2002)
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Vol. 49. Núm. 3.
Páginas 75-78 (marzo 2002)
Acceso a texto completo
High risk haemostasis patterns in overweight patients with type 2 diabetes mellitus
Patrón de hemostasia de alto riesgo en pacientes con sobrepeso y diabetes tipo 2
Visitas
1719
D.A. de Luis**, R. Aller, L. Cuéllar, J.I. Tortosa, E. Romero, D. Bellido, C. Terroba.
Institute of Endocrinology and Nutrition, Medicine School and Hospital Rio Hortega. University of Valladolid. Valladolid Spain.
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Información del artículo
Background

Some studies have shown that diabetic patients had hypercoagulability.

Objective

To compare the haemostasis pattern between overweight diabetic patients and control subjects.

Design

Twenty three overweight patients of our Diabetes Unit chosen at random (16 males/7 females) with type 2 diabetes mellitus were enrolled. The clinical characteristics of these patients were: age of 61.3 ± 12.3 years, body mass index (BMI) 27.2 ± 3.9 kg/m2 and duration of diabetes 8.4 ± 6.7 years. A group of twenty three voluntary controls chosen at random (blood donors) (15 males/8 females) without diabetes were studied. The clinical characteristics of this group were: age 62 ± 13 years and BMI 27.6 ± 3.1 kg/m2. All patients (diabetics and controls) underwent the following examinations; plasminogen activator inhibitor type 1(PAI-1), thrombin/antithrombin III complex (TAT), tissue plasminogen activator (t-PA), von Willebrand antigen (vW), protein C (PC), protein S (PS), thrombomodulin (TH), activated VII factor, D dimer (DD), plasminantiplasmin (PAP), and prothrombin activation fragment F1+2 (F12). Haemostasis parameters were compared in both groups and within the diabetic subjects in the subgroups with and without micro and macroangiopathy. In both groups, correlation analysis was performed between haemostasis and clinical parameters.

Results

Overweight diabetics patients showed an increment in procoagulant parameters (F12 1.38 ± 0.4 vs 1.21 ± 0.25 nmol/l, p < 0.05; VII(a) 94.6 ± 48 vs 81.7 ± 28 (MU/ml); p < 0.05), and a decrease in fibrinolytic parameters (PAP 262.9 ± 107.5 vs 348.5 ± 143 ng/l; p < 0.05), and anticoagulant parameters (Thrombomodulin 27.4 ± 11.7 vs 45.1 ± 21.7 ng/ml; p < 0.05), with a increased in D dimer levels (DD 22.3 ± 26.8 vs 9.7 ± 5.4 µg/l; p < 0.05) and t-PA 12.6 ± 5.1 vs 7.4 ± 3.1 ng/ml; p < 0.05). In diabetic patients, there was no difference according the abscence or presence of microangiopathy or macroangiopathy. In a correlation analysis between HbA1c and haemostasis parameters, only protein C and tPA showed significant negative correlations (r = –0.34; p < 0.01 and r = –0.32; p < 0.05, respectively). A correlation analysis was also performed between BMI and haemostasis parameters and, only FvW was correlated with BMI (r = 0.32; p < 0.05). No correlations were found between haemostasis parameters with BMI and Hba1c in controls.

Conclusion

Hypercoagulable state is present in diabetic patients which with present knowledge, can be viewed as a risk factor for chronic complications.

Key words:
Type 2 diabetes mellitus
Haemostasis
Overweight
Palabras clave:
Diabetes mellitus tipo 2
Hipercoagulabilidad
Sobrepeso
Introducción

Algunos estudios han demostrado un estado de hipercoagulabilidad en los pacientes diabéticos.

Objetivo

Comparar el patrón de hemostasia entre pacientes diabéticos con sobrepeso y controles.

Diseño

Un total de 23 pacientes con diabetes mellitus tipo 2 y sobrepeso atendidos en nuestra unidad fueron incluidos en el estudio (16 varones/7 mujeres). Las características clínicas de los pacientes fueron: 61,3 ± 12,3 años, índice de masa corporal (IMC) 27,2 ± 3,9 kg/m2 y duración de la diabetes 8,4 ± 6,7 años. Un grupo de 23 voluntarios sanos fue elegido al azar entre donantes de sangre sin diabetes mellitus (15 varones/8 mujeres). Las características clínicas de estos pacientes fueron: 62 ± 13 años e IMC 27,6 ± 3,1 kg/m2. A todos los sujetos, casos y controles, se les realizaron las siguientes pruebas: inhibidor del activador del plasminógeno: tipo1 (PAI-1), complejo trombina/antitrombina III (TAT), activador tisular del palsminógeno (t-PA), antígeno Von Willebrand (vW), proteína C (PC), proteína S (PS), trombomodulina (TH), factor VII activado, dímero D (DD), plasmina-antiplasmina (PAP) y fragmento activado protrombina F1 + 2 (F12). Estos parámetros fueron comparados en ambos grupos, y dentro de los diabéticos en los grupos con y sin micro y macroangiopatía. En ambos grupos, se realizó un análisis de correlación entre los parámetros clínicos y los hemostásicos.

Resultados

Los pacientes diabéticos con sobrepeso evidenciaron un incremento en los factores procoagulantes (F12 1,38 ± 0,4 frente a 1,21 ± 0,25 nmol/l; p < 0,05); VII[a] 94,6 ± 48 frente a 81,7± 28 (MU/ml); p < 0,05), y un descenso en los parámetros fibrinolíticos (PAP 262,9 ± 107,5 frente a 348,5 ± 143 ng/l; p < 0,05), así como en los parámetros anticoagulantes (trombomodulina 27,4 ± 11,7 frente a 45,1 ± 21,7 ng/ml; p < 0,05), con un incremento en los niveles de dímero D (DD 22,3 ± 26,8 frente a 9,7 ± 5,4 µg/l; p < 0,05) y (t-PA 12,6 ± 5,1 frente a 7,4 ± 3,1 ng/ml; p < 0,05). En los pacientes diabéticos no hubo diferencia en función de la ausencia o presencia de micro o macroangiopatía. La proteína C y tPA mostraron una correlación negativa (r = –0,34; p < 0,01; y r = –0,32; p < 0,05, respectivamente) con la hemoglobina glucosilada (HbA1c). FvW se correlacionó de una manera positiva con el IMC (r = 0,32; p < 0,05). No se encontraron correlaciones entre los parámetros de hemostasia, con el IMC y HbA1c en los sujetos control.

Conclusión

En los pacientes con diabetes tipo 2, hay un estado de hipercoagulabilidad que puede influir en las complicaciones crónicas de esta población.

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Copyright © 2002. Sociedad Española de Endocrinología y Nutrición
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